Health

Hospitals have gained in recent years thanks to improved facilities and more strategic partnerships

Nipro Pharma Corporation – Japan’s biggest prescription drug contract manufacturer – has nearly completed procedures to increase investment capital by about $270 million to enlarge its facility at Saigon High-tech Park (SHTP) in Ho Chi Minh City so as to increase production volume.

“The procedure completion is expected in the next few weeks, thus increasing Nipro Pharma’s total investment there to $570 million,” a SHTP representative told VIR. “Nipro has performed well since it began investment in the park in 2016.”

Nipro Pharma is among the Japanese investors which have strong interest in Vietnam’s healthcare sector. Many more are expanding to and in Vietnam, according to the Japan External Trade Organization.

Together with Japan, South Korea and the EU also have more sights set on the lucrative local market.

Positive signals

The healthcare sector has welcomed new investment inflows in recent times, especially in 2020 when a number of new projects were announced despite pandemic restrictions. Late last year, a consortium led by Singaporean sovereign fund GIC acquired a minority stake in Vietnam-based private hospital operator Vinmec, part of Vingroup, for $203.1 million.

The year also witnessed VinaCapital using $26.7 million to acquire 30 per cent stake in Thu Cuc International General Hospital; and British Real Capital London’s launch of the $156 million Hong Anh Medical Campus project in Ho Chi Minh City.

In addition to foreign investment, new domestic private capital flows into the sector were also reported during the year. Last January the southern province of Tra Vinh licensed the high-tech pharma project from TV Pharma with initial investment of VND650 billion ($28.26 million). A few months later, the Van Phuc-Saigon Hospital and Hoan My General Hospital projects were also kicked off. Elsewhere, the Long An Obstetrics and Pediatrics Hospital, a public-private partnership (PPP) with Technical World Group being the investors, was put into operation.

The hospital segment is among the most attractive to international financiers and domestic ventures. Since 2015 when the government issued a policy on encouraging private investment in the health sector, over 200 private-run hospitals and more than 35,000 private-owned clinics were built nationwide.

Together with newly-built facilities, existing hospitals are advancing digitalisation projects to cash in on the unmet demands for high-quality services among Vietnamese who were spending an estimated $2 billion on overseas treatment every year before the pandemic.

In addition to infrastructure advances, the trend of focusing on social business programmes has been reinforced by recent moves among multinational corporations like Novartis, Roche, Sanofi, GSK, and AstraZeneca. The moves are in anticipation of a sharp rise in non-communicable diseases thanks to an ageing population.

For example, AstraZeneca Vietnam in collaboration with the Ministry of Health (MoH) and three specialised associations has launched a communications campaign to improve community awareness in asthma management.

Similarly, late last year the Vietnam Medical Association and Roche Vietnam signed a strategic partnership to implement a scheme on improving access to innovative therapies for high-risk breast cancer patients until 2025.

Also last year, GSK Pte., Ltd. in Vietnam signed an MoU with the MoH to fight against antimicrobial resistance in Vietnam, with the deal lasting until 2023.

Despite the growing interest, the quality of such initiatives has yet to satisfy the demand. According to the Vietnam 2035 Report by the World Bank and the Ministry of Planning and Investment, total spending on healthcare in the local market makes up about 5.8 per cent of the country’s GDP, among the highest rates in the region.

New motivations

Like other sectors in Vietnam, the healthcare sector faces a mismatch between the demand for investment and the fiscal space available to meet such demand. In 2016, it was estimated that the public healthcare network would need infrastructure investment of VND176 trillion ($8 billion) for the 2016–2020 period. Since 2010, the government has only allocated and met around two-thirds of capital demand for that period.

Therefore, the government sees private resources as critical to filling that gap, with government master plans for facility investment explicitly directing the MoH and hospitals to mobilise funding from the private sector.

Despite the sector’s importance, private investment in healthcare remains low due to shortcomings including a lack of a legal framework for PPP investment. However, the Law on Public-Private Partnership Investment, which took effect from January, will open the room for private investment in healthcare.

According to a VIR source, the government is gathering ideas from ministries and central agencies for the draft decree guiding the implementation of the law so that it is expected to be issued in the next few days, becoming the key piece of legislation governing PPP transactions in the country.

Under the law, health remains one of the priority sectors for PPP investment. Moreover, some legal concerns among investors are being solved. Specifically, Vietnam will, for the first time, apply revenue risk allocation for related initiatives.

Investors of such projects will be also ensured the right to access and use land and other public assets. Additionally, PPP businesses will enjoy incentives in tax, land use fee, land lease fee, and will be more in line with the prevailing rules on tax, land, and investment.

In addition to the Law on Public-Private Partnership Investment, the new Law on Investment and the new Law on Enterprises are expected to further facilitate capital flows into healthcare.

Moreover, it is projected that the EU-Vietnam Free Trade Agreement will bring more investment opportunities to EU-based pharma businesses in Vietnam and stiffening market competition. The landmark agreement will open the Vietnamese market in fields that businesses have been seeking particular solutions to for years, such as intellectual property rights, direct pharmaceuticals imports, and tenders, among others.

A representative of the MoH said, “Vietnam’s health sector is working on a number of tasks to achieve its goals. The sector always encourages private investment to join.”

Barriers remain

According to the World Bank’s “PPP for Health in Vietnam – Issues and Options” publication, the application of such partnerships in the health sector is still limited despite several facilitators such as the promotion of private investment into healthcare activities, deepening of hospital autonomy, the expansion of universal health insurance coverage, and the development of healthcare credits.

Thus far, a long wish list of 63 projects remains in the health PPP project pipeline. This high number is indicative of ineffective PPP project screening criteria rather than high potential, and only a small percentage of these projects are expected to reach implementation.

Most health PPP projects are proposed and developed at the sub-national level, especially in Ho Chi Minh City, and focus on hospital infrastructure and services rather than on preventive and primary healthcare. They are oriented towards higher-income groups in urban areas rather than disadvantaged groups in rural areas. The proposed health PPP pipeline, therefore, raises serious questions about equity and efficiency in public sector health service delivery.

Furthermore, PPPs have not been embedded in health policies and related regulations, hampering the use of PPPs to expand infrastructure and improve services in the sector. Stakeholders have far greater motivation and incentives to engage in healthcare projects using the joint venture models that were made possible through private investment attraction policy rather than the more complicated and prolonged PPP route.

In the current context, the World Bank experts said that health PPP models and contracts should be adopted with caution. The “asset-heavy, service-light” PPP models, such as equipment and facility PPPs, seem to be the most feasible options. Meanwhile small-scale “asset-light, service-heavy” models such as specialised services and integrated PPPs at the primary healthcare level may be suitable for selected projects for which the private sector has a competitive advantage.

Vietnam, however, does not yet seem to be ready for a fully integrated hospital PPP model because of various barriers in the existing regulatory framework as well as the capacity mismatch between the public and private sectors.

Experts recommend that the MoH should develop a circular guiding the screening, preparation, implementation, monitoring, and evaluation of health PPP projects.

Managing director and national head of Healthcare Luke Treloar and Vo Thi Kim Ngan, associate director at KPMG’s Global Strategy Group

Over the past two decades, Vietnam has achieved laudable improvements in key quality of life metrics such as life expectancy, infant mortality, and access to affordable medicines. This success is the result of the government’s concerted effort to modernise the health system and expand access to affordable care.

Up to now, Vietnam has expanded its universal health coverage to 90 per cent of the population, and targets to reach a 95 per cent coverage ratio by 2025, while maintaining a commitment to sustainable healthcare financing. This coverage ratio and ambition leads comparable regional markets.

The country’s potential is nevertheless still constrained by a relatively high out-of-pocket ratio, while spending the most in-region on healthcare as a share of GDP. If Vietnam wishes to continue to expand access to quality care and maintain sustainable health financing, the health system will need to find a way to provide more services to more patients, at a lower incremental cost.

Digital health is one way to achieve scale of access, improve clinical outcomes, and lower incremental costs. To do this, the government needs to expand market access, and encourage international business and clinical partnerships to drive innovation.

Vietnam is rapidly transitioning from a paper-based medical records system to a digital system. Government-funded hospitals of 24 provinces have committed to deploy electronic health records, with six leading as pilot provinces. At least 80 per cent of patients will have access to digital health records services at national and provincially-controlled hospitals in the near-term, and this access should be extended to at least 95 per cent of the nation by 2025.

Though still on a small scale, telemedicine is expected to serve as a stepping stone to the wider adoption of digital health in Vietnam. During the pandemic, the Ministry of Health (MoH) has piloted telemedicine to encourage social distancing and reduce nosocomial infection risks.

At the same time, the government worked with several hospitals such as Hanoi Medical University to enable remote care in satellite facilities and even patient’s homes.

Vietnam is now seeing the slow but gradual application of AI and big data in healthcare. IBM’s supercomputer Watson is now operating in several Vietnamese hospitals on complex cancer diagnoses and treatment recommendations. Also, the Stanford University machine learning AI platform “RAPID” is now deployed by hospitals like People’s Hospital 115 to diagnose and treat stroke victims.

Digital health can help address capacity constraints faced by most public hospitals – and from a health-economics viewpoint, telehealth and electronic health records will help healthcare providers cut costs by reducing paperwork, improving safety, eliminating duplicate tests, and improving health outcomes and lowering readmittance.

The government is encouraging investors to participate in the development of digital health in Vietnam, and the steps above are a testament to this. We will likely see a further expansion of both domestic and international investors eager to enter the market in line with the government’s commitment to the digitisation of the healthcare system.

However, to fully realise growth potential, remaining issues around technology infrastructure, reimbursement, and regulatory framework should be first addressed.

In 2018, the MoH issued a circular which set the regulatory groundwork for telemedicine by allowing doctors to remotely consult patients, subject to certain IT infrastructure and license requirements. It also provides guidelines for a range of telemedicine activities such as consultation, radiology, and even remote surgery.

However, it does not provide guidance on digital health payment schemes from Vietnam’s Social Security or private insurance providers. Also, there is no legislation specifically governing big data and AI health applications yet, which will slow the implementation of these technologies.

The government can take concrete steps to accelerate digital health adoption through several methods.

First is developing regulations – clarifying regulations governing paying for digital health and using technologies like AI to diagnose and treat patients. Second is expanding health infrastructure digitally in rural clinics to improve access to quality care.

Next up is providing overseas scholarships, by developing collaborations with overseas institutions to train doctors, nurses, and researchers in digital health best practices.

Finally, incentive packages such as tax credits must be created to target the development of digital health infrastructure, in order to promote industry development.

Should these steps be achieved, Vietnam can unlock the full potential of the Vietnamese workforce by promoting the foundation of a digital health ecosystem. Doing so will fuel economic and social development, and further distinguish the country as a regional leader in access to quality medical care.

The Ministry of Health will mobilize all public health facilities and medical students for a vaccination campaign that will use 100 million doses of Covid-19 vaccine this year, said the ministry’s top official at a recent meeting.

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The plan is being made because of pandemic developments including new variants and outbreaks globally.

The department will continue to use available personnel and facilities at designated hospitals for treatment of COVID-19 patients.

These hospitals include Cu Chi COVID-19 Treatment Hospital with 300 beds, Can Gio COVID-19 Treatment Hospital with 600 beds, HCM City Hospital for Tropical Diseases with 40 beds at its Department for Transmissible Diseases D, and the City Children’s Hospital and Children’s Hospital 2.

These hospitals will be ready to increase the number of beds to admit COVID-19 patients and others suspected of having COVID-19 if an outbreak occurs.

If the hospitals become overloaded, the department will use Pham Ngoc Thach Hospital’s 464 beds to admit COVID-19 patients.

The department has instructed hospitals in the city to prepare doctors and nurses to be available for examination and treatment of COVID-19 patients if necessary.

These doctors and nurses will have to receive training in professional knowledge on treatment and control of infections, and ensure safety for medical staff as well as patients.

Last year, the Cu Chi COVID-19 Treatment Hospital and Can Gio COVID-19 Treatment Hospital were the two main health facilities isolating and treating COVID-19 patients and suspected cases. This was done to help reduce pressure and risk of transmission at city hospitals.

The hospitals’ doctors and nurses came from other hospitals in the city and worked on a rotation system.

The department has also instructed the 115 Emergency Centre to continue carrying out its task of transporting COVID-19 patients to designated hospitals for treatment.

Hospitals have helped the city Centre for Diseases Control and Prevention (CDC) to take samples for testing at Tan Son Nhat airport, and bus and railway stations.

Besides the Pasteur Institute and the CDC, tests are conducted by the HCM City Hospital for Tropical Diseases, Children’s Hospital 1, City Children’s Hospital, and Pham Ngoc Thach, Nguyen Tri Phuong, District 2, Thu Duc, FV, Gia An 115 and Hoan My Sai Gon hospitals, as well as several hospitals owned by the Ministry of Health and other agencies.

This year, more hospitals in the city will be assessed for their capacity to conduct COVID-19 tests.

The department has instructed hospitals to prepare medicine, chemicals and protective clothes as well as equipment for their medical staff when they are called for emergencies.

It has also required all hospitals and health facilities to review and assess safety criteria in COVID-19 prevention and control. They have been ordered to ask their patients to fill out online health declarations.

Since February 5, when online health declarations began at hospitals and health centers in the city, 127 private and public healthcare facilities have used the department’s health declaration application.

By March 8, all hospital and health center in the city will have to use the application.

According to the department, hospitals should offer training courses for their doctors and nurses in screening, isolating and taking samples for tests, and treatment guidelines related to COVID-19 issued by the Ministry of Health.

Hospitals have also been instructed to take samples for testing all of their staff by March 10.

Following the Ministry of Health’s requirement, the department is collaborating with Cho Ray Hospital to set up an expert team specializing in COVID-19 treatment to assist other hospitals that admit severely ill COVID-19 patients who need emergency treatment.

Source: VNA

HCM City (VNA) – The Voice of Ho Chi Minh City (VOH), the local official radio broadcasting station, together with the municipal Health Department hosted the first Vietnam medical achievement award ceremony on February 26 to honour 16 contributions to the community’s wellbeing in 2020 from across the nation.

The contributions were voted by the public from 22 nominations selected by the award’s council of professionals. Three months after its launch, the award received more than 60 nominations from medical facilities nationwide.

Among the winners were the work of doctors at the Cu Chi COVID-19 treatment hospital – the first of its kind in Vietnam, and medical staff at the HCM City Centre for Diseases Control. Since the pandemic begin in the country, hundreds of medical workers in Ho Chi Minh City have taken turns to be at the hospital, while preventive medicine workers at the centre have worked day and night on contact-tracing and testing sample collection.

Another was the operation that separated 16-month-old conjoined twins – Truc Nhi and Dieu Nhi, with the sisters now able to walk on their own.  The surgery was performed by 93 doctors and nurses.

VOH Director Le Cong Dong said the award is now an annual event in celebration of Vietnamese Doctors’ Day (February 27).

Duong Anh Duc, Vice Chairman of the municipal People’s Committee, hoped the award will encourage more contributions to the health of the community to be made in the future./.

VNA